May 19, 2010

UK: Why are patients backing the closure of hospitals? Meet the Patients' Champion

Jeremy Taylor, chief executive of National Voices, which represents 15 million patients, explains why some hospitals must be shut down

By Randeep Ramesh

There can be few more explosive issues in healthcare than that of closing hospitals. Even whispers of a service or hospital shutting down can bring local campaigners on to the streets, put politicians on their soapboxes and send doctors into paroxysms of righteous rage. The new secretary of state, Andrew Lansley, campaigned during the election to reopen hospital departments closed in a wave of NHS reorganisations. So, the last people you would think who might dissent are the ones the hospitals were built for: the patients.

Yet just as the election campaign kicked off a letter appeared in the Times, with patients saying the unsayable: "'Save our local hospital' is the line of least resistance and not always the right one." Signed by 46 organisations, the letter was fronted by patient and carers' coalition National Voices. Sitting in his office near the City, Jeremy Taylor, National Voices' chief executive, says he was aware of the political minefield he decided to enter. "We were extremely nervous. But we wanted to provide some thought leadership in the public debate in the absence of anyone else."

Taylor, a former Treasury mandarin, says the lobbying group, which speaks on behalf of 200 organisations and 15 million patients, says its conclusion was no lightning judgment. National Voices began thinking about the issue a year ago. After weighing up the evidence its verdict was clear, says Taylor, "in the future we will need fewer hospital beds".

"The barriers are essentially political and we have a public discourse about healthcare that invests too much emotional baggage in bricks and mortar. We cannot have a proper discussion about closing down hospitals [even though] they may not be in the right place or providing optimal care. That needs to change."

He stresses that this is not a challenge to Lansley. Instead, he says, it is a opinion rooted in fact. Studies have shown that elderly patients with dementia who are left in hospital get worse; the NHS still admits too many people as emergencies – diabetics and asthmatics, for example – because their care has not been managed properly in the community; and the latest hi-tech gadgets and drugs could treat many conditions at doctors' surgeries, even at home.

Fewer beds

"Of course hospitals will be needed, but advances such as day surgery, keyhole surgery, less evasive forms of maternity care ... all add up to fewer beds," he says.

National Voices had been critical of the Tories' plan for a "moratorium" on reconfiguring the NHS, saying that it would simply mean managers planning for changes they thought were inevitable and then springing "consultations on a public who think a decision has already been made".

But Taylor points to an interview that the health secretary gave to the BBC on taking office in which he was careful to say that he was not against closures but that they need backing from doctors and patients.

"We need a new way for communities to be involved in local service change. Existing mechanisms don't work and waste money. They can lead to poor decisions and public disaffection ... So I welcome the health secretary's statements. It's a step forward," Taylor says.

He admits it will not be easy for Lansley to act. Britons do not like closing hospitals. MPs and local councillors can get elected on a "save our local hospital" ticket. He goes as far to suggest political hypocrisy. Local MPs "should not" campaign against hospital closures that, Taylor says, "they agree with in private".

Being a civil servant seems to have turned Taylor, 47, into a campaigner who would rather say "No thanks" than "Yes minister". He is scathing about the mess that the parties fell into over social care funding, saying he was "disappointed" and "frustrated" that nothing came from "months of talks ... no one told people the truth: that they will have to pay more".

He dismisses the casual use of efficiency arguments in the NHS to raise money, saying that survival of the fittest reasoning does not work when "hospitals cannot go bust".

"There needs to be more bravery among the political classes. The reality is that the running and funding of a healthcare system at a time of cash restraint will mean redesigning hospital services. In the past the NHS had lots of money and it could escape difficult trade-offs. Not now."

The NHS budget stands at £127bn, swallowing a fifth of public spending. Given the squeeze on the public finances, Taylor says patients are key to tackling a health service where wages soak up huge amounts of cash and where the medical profession can sometimes stand in the way of reform. "You have got the professions and major acute trusts who are powers in the land. What is missing is a strong commissioning function in the NHS that, informed by patients, can argue the case for changing spending."

National Voices was formed in September 2008 to campaign on health and social care. Taylor signed on six months ago – taking over from a director who put the coalition together.

Chronic illnesses

At the group's core lies patients with chronic illnesses, a powerful patients' block within the NHS. Given that National Voices backs an overhaul of the health service, it is somewhat surprising that Taylor traces the root of current problems to controversial reviews of the health service by then Labour minister Lord Darzi.

The peer wanted to repopulate the NHS with polyclinics – halfway houses between GP surgeries and district hospitals that he believed would provide more convenient and better care for patients who would need to travel less often to hospitals. Importantly, they were to be cheaper than the hospital care they were intended to replace.

"Darzi emphasised the clinical side of things and de-emphasised the patient," says Taylor. "He was good on quality but at the cost of making the analysis less patient-centred. If this is all just cost-driven the patient will lose out. So we'd be looking for a focus on quality."

But there is no escaping the reality that closing hospitals remains an explosive issue. It is not an overstatement to suggest that election results in north London were affected by the intervention of Andy Burnham, the former health secretary, when he intervened in the dying days of the campaign to stop the closure of Whittington hospital accident and emergency services.

In contrast, Burnham did not interfere in Burnley, where a Liberal Democrat candidate launched a weighty battle against the downgrading of the general hospital. The Lib Dems won the seat – unseating Labour for the first time since 1935.

Taylor says he does not want to comment on individuals but says the idea that we are entitled to a hospital is a legacy of "not treating people as grown-ups".

"Politicians are going to have to fess up and prioritise and make trade-offs. They will have to say to the public that the years ahead are not going to be easy and you need to make tough decisions," says Taylor. "The key is to say the changes will lead to better care. Costs may be the spur."

Curriculum vitae

Age 47.

Family Married, with three children.

Lives East London.

Education Gayton high school, Harrow; Harrow Weald sixth-form college; Cambridge University, MA in economics and social and political sciences.